Medicare Part D coverage · empagliflozin · RxCUI 1664321
empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy]
Per the CMS 2026 Part D formulary file, empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy] is covered by 3,292 Medicare Part D plans (65.2% of enrollable products), averaging Tier 2.7, with prior authorization required on 0% of covering formularies.
- 65.2%
- Plan coverage
- 3,292
- Plans covering
- T2.7
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy]
Per the CMS 2026 Part D formulary file, empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy] (RxNorm concept RXCUI 1664321, generic name empagliflozin) appears on 252 distinct formulary files spanning 3,292 Medicare Part D plan offerings - 65.2% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 2.7.
Real-world access to empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 1.2% require step therapy. 89.7% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 1,882,768 Part D beneficiaries filled empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy] in 2023, with total plan-and-beneficiary spending of $8,839,935,063 and an average per-beneficiary annual cost of $4,695.18. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy] today.
Coverage Details
- Formularies covering
- 252
- Plans covering
- 3,292
- Coverage rate
- 65.2%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 1.2% of formularies
- Quantity limits
- 89.7% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,882,768
- Total spending
- $8,839,935,063
- Avg per beneficiary
- $4,695.18
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $0 | NJ |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | No | $0 | GA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | No | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | No | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | No | $0 | AL |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | No | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | No | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | No | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | No | $0 | CA |
Show the next 30 plans
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | No | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | No | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | No | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | No | $0 | NY |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $0 | MO |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | No | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | No | $0 | AR |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Advance (HMO D-snp) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Plus (HMO D-snp) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Health Options West Virginia Inc. | T1 | No | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | No | $0 | DE |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | No | $4.80 | FL |
| Senior Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | No | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | Procare Advantage, LLC | T1 | No | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | No | $4.80 | TX |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy] covered by Medicare Part D?
Yes, empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy] is covered by 3,292 Medicare Part D plans (65.2% of all Part D formularies).
What tier is empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy] on Medicare Part D plans?
empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy] averages Tier 2.7 across Part D plans, ranging from Tier 1 to Tier 6.
Does empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy] require prior authorization?
0% of Part D formularies require prior authorization for empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy]. Step therapy: 1.2%. Quantity limits: 89.7%.
How much does Medicare spend on empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy]?
In 2023, total Medicare Part D spending on empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy] was $8,839,935,063, covering 1,882,768 beneficiaries. The average spend per beneficiary was $4,695.18.
Read our methodology - how this data is sourced, computed, and verified.
Nationwide similar Part D drugs
Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
Similar prior-authorization rate
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